Disruptive Remedies for the Physician Shortage

This article appears in the October 2012 issue of HealthLeaders magazine.

The University of South Florida's Morsani College of Medicine in Tampa has been training physicians since its charter class enrolled in 1971, but apparently Morsani and other medical schools have not done enough. The physician shortage continues to grow, and the general media rarely misses a chance to pound the public with dire projections—as though the answer is to simply push more students through the education pipeline.

One problem with that simplistic thinking is that the pipeline is constrained by all manner of complex relationships. The Association of American Medical Colleges predicts there will be a shortage of 90,000 physicians nationwide by 2020. But that headline number obscures the complex nature of the physician shortage problem by suggesting that either there aren't enough medical schools or that the ones we have are not big enough. Add to that mix the knowledge that under existing predominant care patterns, the Patient Protection and Affordable Care Act will exacerbate the problem by making so many more people eligible for health insurance.

Additionally, some of the shortage can be attributed to other factors:

Physicians are changing their willingness to work long hours

New residencies aren't being created as quickly as new medical schools are

Medical schools and hospitals where impressionable physicians get their early training are doing a less-than-optimal job of preparing new doctors for a rapidly changing workplace in which teamwork with other medical professionals will be at least as important as technical proficiency

The residency problem

Stephen Klasko, MD, who is both CEO of USF Health and the dean at Morsani, says part of the problem in minting new doctors stems less from a lack of medical schools and more from a lack of creativity in developing new residencies.

"The fact is a plethora of states are building new medical schools, but they haven't created new residencies," he says. "Florida has four relatively new medical schools and almost no new residencies."

That's because new residencies are funded primarily by the Centers for Medicare & Medicaid Services—the same federal agency that's under extreme cost pressure for the provision of benefits to its millions of individual beneficiaries.

david rollins (10/26/2012 at 1:24 PM)
There are four ways to fill physician positions in medically underserved areas. ? Expand medical school enrollments and establish more primary care residency programs. ? Raise the financial payments for primary care physicians. ? Open our doors to English speaking foreign physicians. ? Train local people, volunteers, to recruit physicians from the more popular U.S. locations where physicians tend to congregate to the less well known areas where there are few to none. The first two ways are ongoing but time and logistics are required to educate new physicians. The third would antagonize many groups of people and cause an exodus of physicians from our country's friends and neighbors. The fourth, the approach by Citizen-Volunteers Limited, is one that can be implemented immediately. Our vision is for each HPSA having too few primary care providers, high infant mortality, high poverty and/or high elderly population to have access to the physicians that they need. OUR MISSION IS TO ORGANIZE AND TRAIN LOCAL CITIZENS IN THESE HPSAS TO RECRUIT THEIR OWN PHYSICIANS. We are currently raising funds for our Beta Training program. David Rollins, Ex. Director/Founder